| NPI | 1366678450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2015-00115) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC TL37850) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 275162) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2017-12-20 |